Comparison between different reconstruction routes in esophageal squamous cell carcinoma

Table 1 Baseline patient characteristics

Characteristic	Data	Route of reconstruction (%)
		Posterior mediastinal	Retrosternal
Age (yr)
Median	58.3	58.6	58.2
Range	32-79	32-79	34-78
≤ 651	233	90 (75.0)	143 (76.9)
> 65	73	30 (25.0)	43 (23.1)
Sex
Male	237	95 (79.2)	142 (76.3)
Female	69	25 (20.8)	44 (23.7)
BMI (kg/m2)
Median	22.3	22.2	22.3
Range	15.2-35.9	15.2-33.8	15.2-35.9
Smoking index
Median	444.2	483.6	418.7
Range	0-3330	0-3330	0-2000
≤ 4002	174	67 (55.8)	107 (57.5)
> 400	132	53 (44.2)	79 (42.5)
Tumor location
Upper thorax	46	8 (6.7)	38 (20.4)
Middle thorax	153	54 (45.0)	99 (53.2)
Lower thorax	107	58 (48.3)	49 (26.3)
pT status (UICC 7th)
pT1	30	11 (9.2)	19 (10.2)
pT2	55	26 (21.7)	29 (15.6)
pT3	221	83 (69.2)	138 (74.2)
pN status (UICC 7th)
pN0	139	58 (48.3)	81 (43.5)
pN1	93	36 (30.0)	57 (30.6)
pN2	53	16 (13.3)	37 (19.9)
pN3	21	10 (8.3)	11 (5.9)
Tumor grade (UICC 7th)
G1	90	41 (34.2)	49 (26.3)
G2	168	59 (49.2)	109 (58.6)
G3	48	20 (16.7)	28 (15.1)

¹This signals the commencement of “older age” as defined by the World Health Organization (WHO);

²Risk stratification for lung cancer as defined by the WHO. BMI: Body mass index; G: Grade; pN status: Pathological node status; pT status: Pathological tumor status; UICC: International Union Against Cancer.

Table 2 Complications arising when either route of reconstruction was used

Variable	Route of reconstruction (%)		P value
	PM	RS
No. of patients	120	186
Lymphadenectomy
Three-field	29 (24.2)	32 (17.2)
Two-field	91 (75.8)	154 (82.8)	0.137
Pyloroplasty	5 (4.2)	9 (4.8)	0.784
Anastomosis
Left neck	110 (91.7)	176 (94.6)
Right neck	8 (6.7)	6 (3.2)
Intrathoracic	2 (1.7)	4 (2.2)	0.360
Thoracic duct
Reserved	27 (22.5)	80 (43.0)
Ligation	80 (66.7)	104 (55.9)
Resected	13 (10.8)	2 (1.1)	< 0.001
Surgical bleeding (mL)	242.8 ± 114.2	308.2 ± 168.4	< 0.001
Complications (short-term)
Anastomotic leakage	15 (12.5)	23 (12.4)
Cervical	13 (10.8)	19 (10.2)
Intrathoracic	1 (0.8)	2 (1.1)
Mediastinal	0 (0)	2 (1.1)
Esophagotracheal	1 (0.8)	0 (0)	0.573
Chylothorax	2 (1.7)	17 (9.1)	0.008
Pulmonary	50 (41.7)	91 (48.9)	0.214
Cardiac	16 (13.3)	20 (10.8)	0.494
RLN palsy	22 (18.3)	31 (16.7)	0.707
Complications (long-term)
Anastomotic stricture	19 (15.8)	51 (27.4)	0.018

PM: Posterior mediastinal; RS: Retrosternal.

Table 3 Association between recurrent laryngeal nerve palsy, lymphadenectomy, and development of an anastomotic fistula

Variable	Recurrent laryngeal nerve palsy (%)	P value
Lymphadenectomy
Three-field	15 (24.6)
Two-field	38 (12.4)	0.094
Anastomotic fistula
No	42 (15.6)
Yes	11 (28.9)	0.043

Table 4 Univariate and multivariate Cox’s regression analysis predicting overall survival

Factor	Univariate analysis		Multivariate analysis
	HR (95% CI)	P value1	HR (95% CI)	P value1
Age (yr)2	1.642 (1.097-2.460)	0.016	1.013 (0.991-1.035)	0.245
Sex3	0.690 (0.431-1.107)	0.124	0.690 (0.428-1.112)	0.127
BMI (kg/m2)	0.974 (0.917-1.035)	0.400
Smoking index4	1.499 (1.019-2.204)	0.040	1.000 (1.000-1.001)	0.596
Preoperative albumin level (g/L)	0.952 (0.917-0.988)	0.009	0.949 (0.912-0.987)	0.009
Tumor location5	0.872 (0.663-1.148)	0.330
pT6	1.768 (1.209-2.585)	0.003	1.708 (1.163-2.508)	0.006
pN7	1.903 (1.571-2.306)	< 0.001	1.848 (1.525-2.239)	< 0.001
Tumor grade8	0.984 (0.731-1.324)	0.915
Surgical bleeding	1.001 (0.999-1.002)	0.285
Lymphadenectomy	0.655 (0.384-1.115)	0.119	0.779 (0.454-1.339)	0.367
Reconstruction9	1.157 (0.775-1.727)	0.477

¹Cox’s proportional hazards model;

²≤ 65 years of age vs > 65 years of age;

³Male vs female;

⁴≤ 400 vs > 400;

⁵Upper thoracic vs middle thoracic vs lower thoracic;

⁶pT1 vs pT2 vs pT3;

⁷pN0 vs pN1 vs pN2 vs pN3;

⁸G1 vs G2 vs G3;

⁹Posterior mediastinal reconstruction vs retrosternal reconstruction. HR: Hazard ratio; pN: Pathological node; pT: Pathological tumor.